| NPI | 1912156183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 104160) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: AL 104160) |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: AL 104160) | |
| 333600000X Pharmacy (Licence: AL 104160) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AL 104160) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: AL 104160) | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: AL 104160) | |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: AL 104160) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: AL 104160) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2011-02-28 |